Lyme Disease – Fact and Fiction

With the warmer weather, we are already starting to see the ticks come out. Lyme disease is both a controversial and anxiety-ridden topic for many individuals. We hope that we can provide some information and education to shed light on this very charged topic.

What is Lyme disease?

Lyme disease is caused by Borrelia burgdorferi, which is a bacteria that is transmitted to humans by an infected tick. The type of tick is a blacklegged tick (commonly known as a deer tick, Ixodes scapularis). Most of the infected bites are from immature ticks, or nymphs. Nymphs are usually less than 2 mm and challenging to see. Adult ticks can transmit Lyme as well, but because they are larger, they tend to be found sooner before infection occurs.

What are my chances of getting Lyme?

In 2014, there were 1,719 individuals who tested positive for Lyme disease. In the United States, the estimated number of people who test positive for Lyme disease is about 300,000. In order for a deer tick to transmit Lyme it must be attached for at least 24 hours, more likely greater than 36 hours, before transmission of Lyme will occur. Therefore, even in areas where Lyme disease is very common, the risk of acquiring Lyme disease from a tick bite is only about 1.2 – 1.4%.

I found a tick, what should I do?

The best way to remove a tick is to use a set of sharp tweezers and grip the tick as close to the skin as possible. You do not want to use a match, Vaseline or liquid soap because these may irritate the tick and cause it to inject further into the wound. Once you grasp the tick with your sharp tweezers, use firm pressure to pull back steadily. If any head/ mouth parts of the tick are left in the skin, these should be left alone. The body will expel these on its own. If you are confident that the tick was on less for 24 hours you can discard the tick and be sure there was no transmission of Lyme. If you are unsure of how long the tick has been attached, you may save the tick for further identification (deer tick versus non-deer tick), and you may call you doctor for further information.

How do I find out if I really have Lyme?

For many individuals who find a tick that has been attached for greater than 36 hours, it can feel imperative to find out as soon as possible whether or not you may have Lyme. Unfortunately, there is no benefit of blood testing at the time of the tick bite. It takes about two weeks after a tick bite for the Lyme labs to become positive. During that time, one should monitor for signs and symptoms of Lyme disease. The Lyme rash (otherwise known as erythema migrans) is usually salmon color to an intense red. The rash typically expands over a few days to weeks. As it expands, the center can become lighter in color, giving it a “bull’s eye” appearance. This rash is one of the earliest symptoms of Lyme. The rash usually has no associated symptoms such as burning or itching. The rash occurs within a week to a month of the tick bite. The Lyme rash is not to be confused with a local reaction to the tick’s saliva that usually does not expand to larger than a dime in size. Later signs and symptoms include headaches, joint pain or swelling and fatigue, among others.

What are the Lyme tests?

Laboratory blood tests are useful in a situation where there are signs of Lyme disease. It is important to avoid misdiagnosis and treatment of Lyme when there is another cause of the symptoms. The CDC recommends a two part process when testing blood for Lyme disease. The first step is called “EIA”. If this is negative, no further testing is recommended. The second test is called the “Western Blot”. Results are considered positive if both the first and second test are positive. The CDC does not recommend skipping the first test and only doing the “Western Blot”. Skipping the first test leads to an increase in the frequency of false positives, which in turn will lead to improper treatment. Although these tests are not perfect, they can be very helpful in the context of signs and symptoms. If you do test positive via these validated tests and are treated based on recommendations from the CDC, we are confident that most cases of Lyme will be resolved without further incident. The idea of chronic Lyme is not a truly acknowledged condition in the infectious disease community. If further questions, your doctor can help explain the nuances of these tests.

I am so confused by all of the information out there, how do I know what is true?

In an age where information is at our fingertips, it is confusing to know what is true and what is not. In fact, everyone is an “expert” these days. That being said, one should always be discerning about where their information is coming from. At a baseline level, your healthcare provider is the best source of information for any concerns regarding Lyme. Your healthcare provider will decide whether seeing any further specialists is necessary. In some cases, an infectious disease specialist is consulted. Although a popular alternative in the area, “Lyme specialists” are not highly regarded and most often do not have any special medical training in pediatrics, infectious disease, or Lyme. We caution you to speak with us before bringing your child to a “Lyme specialist”. Even some of our local Lyme disease networks and organizations disseminate unproven information regarding Lyme and should not be included in our education. For accurate baseline information, please visit the CDC website.

To ensure that your child is protected against Lyme disease, a tick check should be performed every night. This will hopefully make it much more likely that you will find the tick before the 24 hour mark, alleviating any concerns for Lyme disease. As always, do not hesitate to contact our office with questions or concerns regarding your child and Lyme disease.